All you need to know.

In Ontario, approximately 110,000 people are living with Hepatitis C (Hep C). Roughly 20% of people don’t know they have it. Despite this, there is a lot that you can do to avoid getting Hep C; and, for those already living with the virus, there are more treatment options available than ever before.

Read on for more information on what gay, bi, queer guys need to know about Hepatitis C.

Two men cuddle together. One lays his head on the other's chest and smiles

Hepatitis C (Hep C) or HCV is a virus that can damage your liver. Over time it can cause more serious issues such as scarring (cirrhosis), cancer, and in the most serious cases death. It’s possible to have had Hep C for many years and not even know it.

A small amount of people that get Hep C will clear the infection on their own within 6 months, but the majority will go on to develop a chronic form of the disease. Successful treatment with medication can permanently cure the disease, although becoming infected again is possible.

The time between infection and symptoms appearing differs greatly between people. Many people don’t experience any symptoms at all. If symptoms do appear, they resemble the flu, such as:

  • Fatigue
  • Fever
  • Loss of appetite
  • Stomach pain
  • Joint pain
  • Yellowing of the skin and eyes

Having or not having these symptoms can’t tell you whether or not you are Hep C positive. The only way to be sure if you have Hep C is to take a blood test from your doctor.

Hep C is most commonly spread through blood-to-blood contact. This generally means when one person’s blood is exposed to another person’s blood. Transmission can happen when engaging in activities such as injecting (slamming), inhaling, and snorting while sharing drug equipment. Often this occurs when using needles, pipes, mouthpieces, rolled bills or straws that someone else has previously used.

Additionally, having cracked and bleeding lips due to smoking poses a risk. Be sure to keep your lips moisturized with lip balm. If you are planning to fist after injecting, blood may be present on your arm and can pose a risk as well. 

The virus can also live outside of the body for up to 6 weeks, so, you can still contract Hep C by using old needles, pipes, and snorting materials. A dull needle can also increase your chance of getting Hep C because it may take more attempts to inject properly.  

It’s also important to ensure that injecting and smoking equipment are disposed of in a sharps bin to avoid repeated use and accidental exposure. 

Practicing this rule looks like everyone using their own needle, mouthpiece or snorting tool every time they use substances. Slamming, inhaling, snorting and fisting kits are available at ACT for free, as well as sharps bins and other drug tools. To find out more or to order supplies, email    

Getting Hep C through sex is rare, but it has been known to happen. We now know that several factors can affect your level of risk.

Since Hep C can be passed through blood, any sexual activity where blood may be present may also lead to getting the virus. Because the lining of your butt is delicate, anal sex can lead to tears allowing the virus to pass more easily. This happens most commonly with:

  • Rough sex
  • Group sex or sex with multiple partners
  • Sex where drugs are involved, since drugs can lower inhibitions and lead to enhanced, prolonged play
  • Sex involving injecting (slamming) drugs

Some studies have also shown that the Hep C virus can be found in detectable amounts in sexual fluids such as semen. It may be possible to get Hep C through bareback sex, but the specifics are still being studied. This seems to be particularly true for guys living with HIV, although the exact causes and reasons are not fully understood.

Condoms help to reduce the risk of many STIs, including Hep C, by limiting the amount of blood and semen exposure during sex. It’s important to remember to change condoms between every partner.

If you’re engaging in activities that involve stretching like fisting, using barriers like gloves, changing barriers between partners, and using enough lube, you can keep you and your partner(s) safer. Check out our guide on Fisting and Gloves.

Over the past decade, more and more evidence has shown that gay, bi, queer guys living with HIV are at an increased risk of also becoming Hep C positive. Some studies have shown that HIV positive gay, bi, queer guys are less likely to clear the infection on their own, and often progress to the chronic form of the disease. This is true even for guys who never inject drugs. It’s important to note that the reasons for this aren’t entirely clear, but there are some things we do know.

HIV and Hep C can be passed through blood and potentially semen, so it’s possible to acquire both through similar activities. Since HIV weakens your immune system, it can make you more vulnerable to other illnesses if left untreated. Having both at the same time is called a co-infection.

Activities that can lead to an HIV and Hep C co-infection include:

  • Having sex without condoms (barebacking)
  • Having group sex or multiple sexual partners
  • Using drugs and sharing needles during sex, since drugs can lower inhibitions and lead to enhanced, prolonged play
  • Having an untreated STI like syphilis, as open sores from STI’s increase risk

Trying to avoid or limit these activities can help reduce your risk, in addition to the other sexual transmission tips like using condoms, getting tested and wearing gloves while fisting. Guys living with and affected by HIV can rely on U=U for peace of mind regarding HIV, but it’s important to know that being HIV undetectable doesn’t appear to provide any protection against passing on or receiving Hep C.

If you test positive for Hep C, your HIV status should be discussed with your doctor before starting treatment. The medications used to treat HIV and Hep C can have negative interactions: if you are taking HIV meds and are undetectable, this can mean a change in your medications; if your HIV is untreated, it will likely be treated before Hep C since HIV can cause Hep C to advance faster. For HIV treatment and prevention options, check out

If you get Hep C, it can be cured. About 1 in 4 people can clear the infection on their own, but for the majority of people, treatment is required. The only way to know if you have Hep C is to get tested and getting tested leads to sooner treatment and recovery. Treatment involves taking direct-acting antivirals or DAAs, which are tablets taken for 8-12 weeks. Side effects are usually mild and well tolerated. More than 95% of people who receive treatment are cured. To get tested or treated, contact your healthcare provider or a doctor.

Without getting treated, your body likely won’t clear the virus on its own, leading to a chronic infection. Curing Hep C can prevent your liver from further damage and reduce symptoms like fatigue and body aches. While having HIV can make you more prone to Hep C, those with an HIV and Hep C co-infection have cure rates for Hep C as high as someone without a co-infection.

Although it’s curable, getting Hep C once doesn’t provide any immunity, and it’s possible to get it again after being cured. Follow our tips above to help reduce your risk, and make hep C testing a regular part of your sexual health screenings.